BOOKS/Alvena Bieri

Critical Condition

Donald L. Barlett and James B. Steele, two well-known,
award-winning journalists, have some excellent ideas for solving one
of America's greatest problems, expensive and inefficient health
care. In Critical Condition: How Health Care in America Became Big
Business and Bad Medicine [New York: Doubleday, 2004], they
give a vivid description of the situation, and at the end they have
an equally compelling solution.

Readers of publications like The Progressive Populist and books
on social problems, if you're like me, are used to plowing through a
book that presents an important fault in our system, eager to get to
what remedy is. In this book the cure sounds so good, so full of
common sense, I almost wish they had put it first.

The dilemmas, the ironies, the troubles with the complicated,
unfair health system in the US right now are overwhelming, causing
pain for poor and innocent citizens. The authors start with some
stories of garage sales and other events held to help families with
sick children pay their astronomical medical bills. All the while
they are successfully refuting the popular myth, believed by many,
that the United States has the very best healthcare system in the
world.

We know there are at least 44 million people in this country with
no health insurance at all, and there are many more who are
underinsured. What we may not realize is that, unlike most retailers
or merchants who charge the same price to everyone who comes into
their store to buy an item, healthcare providers do not.

The sad fact is that the patients without insurance are often
charged more. A good example is at the University of Oklahoma Medical
Center, Oklahoma City, part of HCA, Hospital Corporation of America.
They say that in one instance an uninsured patient there was charged
$85,400 for a craniotomy. Most insurers would have paid $15,600 for
it, and Medicare would have put out $13,900.

So Barlett and Steele often use the word "chaotic" to describe
our system, and they compare it unfavorably to health care in most
other industrialized nations, such as Canada and many European
countries. "What does it say," they keep asking, "about the richest
country on earth that its citizens must depend upon raffles and
spaghetti dinners to pay the medical bills -- a situation that
exists in no other civilized country?"

The authors also criticize the advertising and promotions of big
drug companies. Lipitor is mentioned with a statistic. On page 209 it
says that one-third of all people who die of heart disease actually
have low cholesterol!

The last chapter is called The Remedy, and overall it stresses
the need for simplicity in a good system of health care. Their
recommendation -- not a surprise -- is for a universal,
single-payer system. Medicare is that now and is a success, except
maybe for the new and confusing drug benefit.

A new system would be tax-supported with a gross-receipts tax on
businesses and a flat tax. It would be modeled on the Federal Reserve
system, which they say is a "quasi governmental" organization
independent of politics. Members of its governing board serve rather
long terms, 14 years, and are appointed by the President with the
Senate's approval. It could be called the United States Council of
Health Care, or USCHC.

Overall, such a system would cut costs or corporations, raise
taxes a little on those at the top and be much better than the "free
market" arrangement we have now. The emphasis would be on preventive
and basic care. It would pay absolutely all bills associated with a
serious illness, and let patients choose their own doctors and
hospitals.

Barlett and Steele's concluding sentence will be mine too: "We
can continue to hold garage sales to finance health care, or we can
do what every other civilized nation on earth does -- take care of
our citizens."